Conference Abstract

Innovative Models for Improving HIV Case Management Services

G Huba, T Larson, B Singer, L Melchior, J Zalumas, L Wolfe, K Uldall, J Steinberg, A Stanton, G Smereck, J Rips, P Reis, K Meredith, S McDonald, J Kaplan, E Jean-Louis, J Hubbs, R Henderson, H Henderson, C Grace, V German, T Gallagher, G Falus, M Driscoll, H Cruz, P Chase, V Brown, J Bartlett, & D Anderson.

A systematic approach to changing the way health and social services are provided is needed to improve programs for people living with HIV. This paper will present a three-level approach being taken collectively by a croup of 27 grantees of the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. This paper focuses on case management services. In 1994, the SPNS Program funded an HIV Innovative Model of Care Initiative consisting of 27 cooperative agreements, HRSA, and an Evaluation and Dissemination Center. Projects participate in the Steering Committee for the cooperative agreements as a condition of funding. The cooperative agreement funding mechanism was chosen to promote joint decision making, common evaluation, and pooling of technical expertise. HIV case management services are addressed at three levels among the cooperative agreement projects: 1) direct services (including hospital-based as well as community based programs); 2) training of service providers in issues specific to HIV case management; and 3) policy advocacy designed to change the service system infrastructure to improve the way HIV case management services are provided. Since January 1995, the SPNS Cooperative Agreement Steering Committee has met eight times in 24 months and held a national evaluation conference. In aggregate, the 27 grantees have provided direct services to 1,595 individuals with HIV, and have trained 16,702 persons in a collective set of 631 training. A special ad hoc group has formed to specifically address barriers to services and how to reduce them through case management; these trends are also addressed by individual projects, and as cross-cutting themes shared by multiple projects. Through sharing of technical expertise and experiences, both cooperative and individual goals have been enhanced. The participants believe that the model can be transferred to other HIV service projects that wish to pool their strengths. It is proposed that change is needed at all three levels individual case management delivery programs, training to providers, and policy advocacy/infrastructure change - to effect profound change in the way case management services are provided for individuals with HIV and their families. One way to achieve this is to form a ‘cooperative agreement’ of professionals seeking to enhance the services system at all these levels and to have them regularly collaborate and share individual expertise.

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